HX64077837 
RA790  N21 3  War  work  and  other  s 


RECAP 


Rational   committee  for  mental  hygiene,    "lev;  York 


/ar  #ork  and   other   special   activities. 


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COLLEGE  OF 

PHYSICIANS  AND  SURGEONS 

LIBRARY 


WAR  WORK 

AND  OTHER 

SPECIAL  ACTIVITIES 

OF 

The  National  Committee  for  Mental  Hygiene,  Inc. 


FOREWORD  BY 
CLIFFORD  WHITTLNGHAM  BEERS 

Founder  and  Secretary 


PRINTED  FOR  PRIVATE  DISTRIBUTION 


WAR  WORK 

AND  OTHER 

SPECIAL  ACTIVITIES 

OF 

The  National  Committee  for  Mental  Hygiene,  Inc. 


FOREWORD  BY 
CLIFFORD  WHITTINGHAM  BEEES 

Founder  and  Secretary 


PRINTED  FOR  PRIVATE  DISTRIBUTION 


CONTENTS 


Foreword  .... 

I.     War  Work       .... 
II.     Care  and  Treatment  of  the  Feeble-minded 

III.  Public  Care  and  Treatment  of  the  Insane 

IV.  Study  of  Conditions  in  a  Community 

Y.     Studies  of  the  Mental  Factors  in  Crime 

Psychopathic  Clinics  at  Sing  Sing  Prison  and  the 
Children's  Court  in  New  York  City 

VI.    Uniform  Statistics  on  Mental  Diseases 


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7 
11 
14 
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Digitized  by  the  Internet  Archive 

in  2010  with  funding  from 

Open  Knowledge  Commons 


http://www.archive.org/details/warworkotherspecOOnati 


FOREWORD 

In  a  talk  I  had  with  Mrs.  Edward  H.  Harriman  a  while  ago, 
she  said,  "  When  you  tell  of  the  need  for  funds  for  your  work  at 
the  meeting  held  in  my  home,  be  sure  to  say  that  giving  to  an 
efficient  and  needed  organization  is  not  charity,  but  an  invest- 
ment which  pays  dividends  in  the  form  of  benefits  to  mankind, 
that  is,  it  is  constructive  philanthropy,  not  charity." 

At  the  recent  meeting,  which  you  honored  with  your  pres- 
ence, I  said  a  great  deal  about  the  need  for  funds  for  use  in 
developing  and  maintaining  the  general  work  of  The  National 
Committee  for  Mental  Hygiene ;  and  I  told  of  the  dividends  in 
the  form  of  ''benefits  to  mankind"  that  had  been  secured 
through  its  general  work.  I  was  not  able,  however,  because  of 
lack  of  time,  to  give  deserved  emphasis  to  the  extra  dividends 
secured  by  the  organization  through  its  ability  to  administer 
special  gifts  for  special  purposes  which  have  been  donated  and 
will,  without  doubt,  continue  to  be  given  from  time  to  time  if 
the  National  Committee  can  maintain  its  machinery  of  opera- 
tion on  an  effective  basis. 

Some  of  the  special  work  carried  out  under  appropriations 
which  are  not  available  for  general  expenses  are :  War  work 
in  behalf  of  the  soldiers  and  sailors  who  are  developing  nervous 
or  mental  disorders  while  serving  the  Nation  at  home  or 
abroad;  surveys  and  special  studies  relating  to  the  feeble- 
minded and  to  the  insane ;  demonstration  studies  in  the  psycho- 
pathology  of  crime,  such,  for  instance,  as  the  maintenance  and 
supervision  of  the  mental  clinic  at  Sing  Sing  Prison,  and  the 
clinic  connected  with  the  Children's  Court  in  New  York  City ; 
and  special  statistical  studies,  which  are  already  helping  to 
bring  about  the  long-needed  adoption  of  uniform  statistics 
throughout  this  country  with  reference  to  mental  diseases. 

This  pamphlet  contains  a  succinct  account  of  these  special 
activities  and  is  based  on  material  written  originally  by  Dr. 
Thomas  W.  Salmon,  Medical  Director  of  The  National  Committee 
for  Mental  Hygiene,  who  has  been  granted  leave  of  absence  to 
serve  as  a  Major  in  the  Medical  Officers'  Reserve  Corps  of  the 

[5] 


United  States  Army  in  France,  where  he  is  in  charge  of  the 
care  and  treatment  of  the  members  of  the  Expeditionary  Forces 
who  develop  nervous  or  mental  trouble  while  in  the  service. 
The  report  takes  on  the  added  value  of  an  impartial  and  objec- 
tive summary  because,  with  the  exception  of  a  few  paragraphs, 
it  was  compiled  by  Mr.  Edwin  R.  Embree,  Secretary  of  the 
Rockefeller  Foundation,  for  use  in  informing  the  members  of 
that  organization  of  the  results  accomplished  by  the  National 
Committee  with  the  appropriations  given  to  it  by  the  Founda- 
tion for  the  special  purposes  mentioned. 

Requests  have  been  made  recently  to  The  National  Com- 
mittee for  Mental  Hygiene  to  undertake  additional  special 
studies  with  reference  to  the  mental  factors  in  important  social 
problems.  Unless  adequate  financial  support  is  secured,  how. 
ever,  for  the  maintenance  of  its  general  work,  it  will  be  almost 
impossible  to  administer  any  additional  special  gifts  for  special 
purposes,  as  no  part  of  these  gifts  is  available  for  the  general 
overhead  expenses  of  the  organization.  In  a  word,  the  National 
Committee  is  in  danger  of  being  placed  in  a  position  similar  to 
that  of  many  an  educational  institution  which,  while  receiving 
gifts  for  special  purposes,  oftentimes  has  to  struggle  to  keep 
its  administrative  machinery  in  effective  operation.  Contribu- 
tions and  pledges  towards  the  general  expenses  are,  in  conse- 
quence, indispensable  to  the  continued  success  of  The  National 
Committee  for  Mental  Hygiene. 

Clifford  W.  Beers. 


[6] 


I.  WAE  WORK  IK  MENTAL  HYGIENE 

The  war  work  of  the  National  Committee  for  Mental  Hygiene 
was  inaugurated  in  April,  1917,  as  a  result  of  a  special  study- 
made  by  Dr.  Thomas  W.  Salmon,  its  Medical  Director,  and  by 
Dr.  Pearce  Bailey  and  Dr.  Stewart  Paton,  members  of  the 
organization. 

It  became  possible  to  inaugurate  war  work  promptly, 
because  of  the  timely  gift  of  Miss  Anne  Thomson  of  Devon, 
Pennsylvania,  who  generously  contributed  $15,000  for  this 
special  purpose  to  the  National  Committee  for  Mental  Hygiene, 
shortly  after  war  was  declared.  Her  gift  financed  this  work 
until  October  1,  1917,  since  which  time  it  has  been  carried  on 
under  a  special  grant  of  $25,000  made  to  the  National  Commit- 
tee by  the  Eockefeller  Foundation. 

In  May,  1917,  Dr.  Salmon,  under  a  special  appropriation 
from  the  Rockefeller  Foundation,  went  to  England  and  made 
a  special  study  of  mental  disorders  and  war  neuroses  in  the 
British  Army.  His  report  and  his  counsel  have  been  of  funda- 
mental assistance  to  the  Surgeon-General  in  making  plans  for  the 
treatment  of  nervous  and  mental  cases  in  the  American  Army. 

When  Dr.  Salmon  went  abroad  in  May,  1917,  Dr.  Pearce 
Bailey  became  Chairman  of  the  War  Work  Committee  of  the 
National  Committee,  and  Dr.  Frankwood  E.  Williams,  Associate 
Medical  Director  of  the  organization,  became  Vice-Chairman. 
In  July,  1917,  Dr.  Bailey  accepted  a  commission  in  the  Medical 
Reserve  Corps  of  the  Army  and  became  adviser  on  psychiatry 
and  neurology  in  the  office  of  the  Surgeon-General  at  Washing- 
ton, with  rank  of  Major,  which  has  lately  been  changed  to 
Colonel.  Until  recently  the  active  war  work  of  the  National 
Committee  has  been  directed  by  Dr.  Frankwood  E.  Williams, 
who  has  now  accepted  a  commission  in  order  to  assist  Col. 
Bailey  at  Washington  in  work  relating  to  the  reconstruction 
and  rehabilitation  of  soldiers  invalided  home  because  suffering 
from  nervous  or  mental  disorders.  The  war  work  of  the 
National  Committee  is  expanding  rapidly  and  is  now  under  the 
direction  of  Dr.  Charles  L.  Dana,  Chairman  of  its  War  Work 

Committee. 

[7] 


With  its  Medical  Director,  Major  Salmon,  in  charge  of  the 
neuro-psychiatric  work  of  the  American  Expeditionary  Forces 
in  France;  with  the  first  Chairman  of  its  War  Work  Com- 
mittee, Col.  Bailey,  in  charge  of  the  Division  of  Psychiatry  and 
Neurology  in  the  office  of  the  Surgeon-General  at  Washington ; 
and  with  its  Associate  Medical  Director,  Dr.  Williams,  in  charge 
of  important  duties  in  the  same  office  at  Washington,  it  would 
seem  that  the  National  Committee  for  Mental  Hygiene  is  ren- 
dering very  direct  aid  to  the  Government  in  the  prosecution  of 
the  war.  Needless  to  say,  its  members  find  satisfaction  in  this 
new  proof  of  its  value  as  a  social  agency. 

PROBLEM 

One  of  the  striking  facts  of  the  war  is  the  large  number  of 
soldiers  suffering  from  "  shell  shock "  or  war  neuroses.  The 
amount  of  nervous  and  mental  disease  is  unprecedented.  One- 
seventh  of  the  discharges  from  the  British  Army  have  been 
from  these  causes — one-third  of  the  discharges,  if  the  wounded 
are  excluded. 

Specific  problems  involved  in  view  of  this  situation  are : 

1.  Elimination  from  military  service  of  the  mentally 
and  nervously  unfit. 

2.  Care  and  treatment  of  those  likely  to  succumb  or 
actually  incapacitated. 

3.  Reconstruction  and  return  to  the  army  or  to  civil 
life  of  those  nervously  or  mentally  disabled. 

WAR  PROGRAM  OF  THE  NATIONAL  COMMITTEE 
FOR  MENTAL  HYGIENE 

The  program  of  the  National  Committee  for  assistance  to 
the  United  States  Government,  inaugurated  in  April,  1917, 
includes : 

1.  Creation  of  Division  of  Psychiatry,  Neurology  and 
Psychology  in  Medical  Corps,  U.  S.  A.  (Col.  Pearce  Bailey  in 
charge  of  Division,  Major  Robert  M.  Yerkes,  head  of  Psycho- 
logical Section). 

(a)  Obtaining  psychiatrists  and  neurologists  to  take 
commissions  in  work  in  their  specialty  in  the  Medical 
Corps.     Over  300  already  in  service,  others  daily  accept- 

[8] 


ing  commissions.  Practically  all  correspondence  prelimi- 
nary to  issuance  of  commissions  has  been  carried  on  by 
National  Committee.  Current  scientific  literature  is 
regularly  supplied  to  this  Corps  by  the  Committee. 

(6)  Establishment  of  special  schools  in  military  neuro- 
psychiatry for  reserve  officers. 

2.  Exclusion  from  Army  of  mentally  and  nervously  unfit. 

This  is  the  first  attempt  of  any  nation  to  raise  an 
army  free  from  those  unfit  nervously  and  mentally,  as 
well  as  physically. 

In  this  the  National  Committee  has  given  special 
assistance  by 

(a)  Studying  conditions  in  Allied  armies  and  making 
reports  which  brought  about  present  order  of  exclusion. 

(6)  Preparing  examinations  which  make  this  exclusion 
effective.  Over  12,000  men  have  been  excluded  to  date 
(May  1,  1918)  by  these  examinations.  The  importance  of 
eliminating  those  in  any  way  unfit  is  even  greater  for 
American  than  for  European  armies  because  of  shipping 
scarcity. 

3.  Care  for  those  likely  to  succumb  or  actually  incapaci- 
tated : 

(a)  Preparation  of  plans  for  special  neuro-psychiatric 
wards  which  are  being  attached  to  military  hospitals  in 
cantonments  and  in  the  field. 

(&)  Selection  and  standardization  of  equipment  for 
these  wards. 

(c)  Eecruiting  skilled  nursing  personnel,  both  women 
and  men.  The  names  of  about  1,400  men,  who  Lave  had 
experience  in  civilian  institutions  in  nursing  patients  with 
nervous  and  mental  disorders,  have  been  furnished  for 
assignment  to  such  service  in  the  army.  The  names  of 
several  hundred  women  who  have  had  experience  with 
nervous  and  mental  cases  have  also  been  furnished  to 
the  Government,  a  large  number  of  whom  are  now  on  duty. 

Plans  for  care  of  the  Expeditionary  Force  include  preparation 
for  prevention  of  nervous  and  mental  disorders  by  presence  of 
neurologists  and  psychiatrists  as  observers,  who  will  withdraw 
temporarily  for  treatment  those  showing  first  signs  of  break- 
down. The  ultimate  "  shell  shock  "  is  but  the  end  of  a  long 
train  of  shocks   and  it  has  been  demonstrated  that  trained 

[9] 


observers  can  in  many  cases  prognose  the  situation  and  prevent 
the  expected  result.  Plans  also  include  early  diagnosis  and 
prompt  treatment  of  those  who  succumb,  the  return  to  service 
of  those  who,  as  a  result  of  this  prompt  and  scientific  care, 
recover,  and  the  continued  treatment  of  those  seriously  ill. 

4.   Eeconstruction : 

(a)  Recommendation  of  changes  in  military  regula- 
tions for  discharge  and  transfer  home  of  men  suffering 
from  nervous  and  mental  diseases.  Eegulations  are 
now  in  harmony  with  best  civil  practice. 

(6)  Obtaining  co-operation  of  States  in  receiving  arid 
care  for  men  discharged  for  mental  causes.  To  date 
(May  1,  1918)  forty-four  States  have  agreed  to  co  operate. 

(c)  Recruiting  skilled  occupational  and  special  work- 
ers for  reconstruction  of  the  discharged  men. 

The  War  Work  Committee  of  the  National  Committee 
for  Mental  Hygiene  is  advising  authorities  at  Columbia 
University  and  at  Vassar  and  Smith  Colleges,  with  refer- 
ence to  special  occupational  therapy  courses,  where 
women  are  to  prepare  themselves  for  reconstruction  work 
among  soldiers  invalided  home  because  of  nervous  or 
mental  trouble. 

In  this  pamphlet  it  is  impossible  to  do  more  than  outline  the 
war  work  done  and  planned  to  date  (May,  1918).  Those 
desiring  detailed  information,  however,  and  news  of  new 
developments,  may  secure  it  for  the  asking  from  the  National 
Committee  for  Mental  Hygiene,  50  Union  Square,  New  York. 


[10] 


II.*   CARE  AND  TREATMENT  OF  THE 
FEEBLE-MINDED 

Problem  : 

The  widespread  prevalence  of  f eeble-mindedness  has  within 
only  recent  years  been  generally  recognized  as  a  sonrce  of 
wretchedness  to  the  patient  and  to  his  family  and  as  a  contrib- 
uting cause  of  crime,  prostitution,  illegitimacy,  intemperance 
and  other  complex  social  diseases. 

Method  of  Attacking  the  Peoblem  : 

While  there  is  much  still  to  learn  about  feeble  mindedness 
there  is  at  present  a  sufficient  body  of  indisputable  facts  to 
warrant  the  adoption  of  an  extensive  program  for  dealing  with 
these  defectives.  There  is  definite  medical  and  social  knowl- 
edge to  determine. 

1.  The  existence  of  feeble-mindedness  in  the  vast 
majority  of  cases  presented  for  examination. 

2.  That  the  best  method  of  prevention  is  continued 
institutional  care. 

3.  The  kinds  of  institutional  care  which  are  best  for 
the  individual  and  for  society. 

4.  Methods  of  dealing  with  feeble-minded  children  in 
the  school. 

5.  Conditions  under  which  the  feeble-minded  may 
with  comparative  safety  be  permitted  to  remain  in  the 
community. 

Not  knowledge,  nor  general  interest,  nor  a  wish  to  deal  with 
the  problem  is  lacking,  bat,  in  nearly  every  state,  a  framework 
of  law  and  an  administrative  mechanism  based  solidly  upon  it 
that  will  make  it  possible  to  carry  out  measures  already  gener- 
ally agreed  upon. 

♦Sections  II  to  VI  are  extracts  from  a  report  to  the  Rockefeller  Foundation  by 
its  Secretary,  on  special  work  carried  out  by  the  National  Committee  for  Mental 
Hygiene  under  special  grants  from  the  Foundation. 

[11] 


To  overcome  this  lack  the  Foundation  has  provided  funds 
which  enable  the  National  Committee  for  Mental  Hygiene  to 
contribute  the  services  of  well  trained  physicians  to  act,  when 
invited,  as  surveyors  and  advisors  to  State  Commissions  on 
Provision  for  the  Feeble-minded,  when  appointed  by  Governors 
or  State  Legislature. 

Such  assistance  has  been  given  to  Commissions  in  Kentucky 
and  Maine  and  is  planned  in  Mississippi  and  Louisiana. 


KENTUCKY 
Service  rendered  1917 

Cost :    About  $4,000. 

Invitation :  Kentucky  Commission  Provision  for  the  Feeble- 
minded. 

Work  in  charge  of :  Dr.  Thomas  W.  Haines,  who  served  as 
Secretary  to  the  Commission  while  making  the  study. 

Report:  Existence  of  pauper  idiot  act,  an  anachronism 
dating  from  1793,  which,  by  giving  a  yearly  allowance  to  the 
parents  or  custodians  of  a  feeble-minded  person,  places  a 
premium  on  the  birth  or  presence  in  the  home  of  mental 
defectives. 

People  of  Kentucky  have  failed  to  understand  the  problem 
of  feeblemindedness  because,  through  lack  of  dependable  data, 
it  had  not  been  defined. 

Dr.  Haines's  report  gives  for  the  first  time  a  fairly  complete 
body  of  facts  in  regard  to  the  feeble-minded  in  the  State, 
including  an  estimate  of  their  number  and  location,  their  part 
in  accentuating  and  perpetuating  other  disturbing  social 
problems,  and  a  review  of  the  confusing  and  costly  methods 
now  in  use  in  that  State  in  dealing  with  these  defectives. 

Results :  Eecommendations  presented  to  the  Legislature  by 
the  Commission  and  enacted  into  law : 

(a)  To  abolish  the  Pauper-Idiot  Act. 

(b)  To  enact  new  legislation  to  provide  for  the  identification, 
special  training,  custodial  care,  and  supervision  in  the  com- 
munity, of  the  feeble-minded. 

(c)  To  establish  additional  institutions. 

[12] 


MAINE 

Service  rendered  for  one  year  beginning 
September,  1917 

Estimated  cost :   $7,500. 

Invitation :  Governor  of  Maine,  who  has  appointed  a  State 
Commission  on  Provision  for  the  Feeble-minded. 

Work  in  charge  of:  Dr.  Guy  G.  Fernald,  Psychiatrist  at  the 
Massachusetts  ^Reformatory  at  Concord  (on  leave  of  absence). 

Report :   Work  still  in  process. 

Expected  Results :  The  report  when  finished  will  be  used  by 
the  Commission  in  its  work  before  the  Legislature. 

Work  already  done  has  aroused  interest  in  the  plan  for 
organizing  a  State  Society  for  Mental  Hygiene. 


[13] 


III.  PUBLIC  CARE  AND  TREATMENT  OE 

THE  INSANE 

Problem  : 

The  care  of  the  insane  in  different  parts  of  the  United 
States  shows  the  widest  variation,  and  in  most  places  has 
failed  to  keep  pace  with  the  great  advances  recently  made  in 
the  care  and  treatment  of  other  classes  of  the  sick. 

In  many  states  insane  patients  receive  only  custodial 
care,  persons  with  curable  mental  diseases  often  failing 
to  recover  on  that  account. 

In  other  states  many  of  the  insane  are  in  poor  farms, 
jails  and  prisons;  under  such  conditions  neglect  and 
cruelty  are  common. 

In  only  a  few  states  are  all  of  the  insane  cared  for  in 
state  hospitals,  most  of  which  are  overcrowded. 

Political  appointments  are  made  in  some  institutions, 
and  in  many  states  entire  change  in  hospital  organizations 
follows  changes  in  the  state  administration. 

Often  recoverable  cases  are  held  in  jails  or  other 
places  of  detention  during  the  early,  critical  period  of 
illness,  and  when  at  last  transferred  to  hospitals  are 
taken  by  policemen  or  county  officials,  women  patients 
often  being  in  charge  of  men. 

The  internal  arrangement  of  hospitals  and  the  classifi- 
cation of  patients  are  often  inadequate,  they  are  rarely 
standardized,  medical  staffs  are  usually  too  small,  nursing 
services  are  crude,  attendants  are  underpaid  and  insuffi- 
cient in  number ;  facilities  for  instruction  of  nurses  and 
attendants  are  often  wholly  lacking  and  the  use  of 
mechanical  restraint  is  far  too  common. 

In  most  states  little  or  no  scientific  study  of  patients 
is  made,  consequently  individual  treatment  is  impossible, 
there  are  no  standards  for  proper  case  records  and  no 
opportunities  for  medical  research.  Appreciation  of  the 
value  of  trained  occupation  instructors,  social  service 
workers  and  recreation  directors  is  spreading  too  slowly. 

Facilities  for  instruction  in  psychiatry  are  meager 
and  postgraduate  training  in  psychiatry  is  practically 
unobtainable. 

[14] 


Legal  requirements  vary.  In  some  states  patients 
must  be  publicly  tried  by  jury  in  open  court  and  be 
"  convicted  "  of  insanity  before  admission  to  a  hospital  is 
possible. 

Prevention  of  mental  disorders  receives  little  atten- 
tion. Much  is  known  concerning  their  nature  and  causes 
which  might  be  employed  in  preventing  them. 


Method  of  Attacking  the  Problem: 

Accurate,  impartial  and  scientific  surveys  of  actual  condi- 
tions in  given  states  form  the  basis  upon  which  effort  for 
improving  conditions  must  rest. 

Such  surveys,  carried  out  by  the  National  Committee,  with 
the  support  of  the  Eockefeller  Foundation,  have  been  com- 
pleted in  California,  Colorado,  Cook  County  (Illinois),  Con- 
necticut, Georgia,  Louisiana,  New  York  City,  Pennsylvania 
(supplementary),  Tennessee  and  Indiana.  Before  funds  for 
surveys  were  appropriated,  Dr.  Salmon  had  arranged  for  and 
supervised  surveys  in  Pennsylvania,  South  Carolina  and  Texas, 
expenses  being  met  by  local  organizations  or  the  National 
Committee. 

In  addition  to  the  concrete  results,  described  on  following 
pages,  there  is  also  the  fundamental  accomplishment  of  accurate 
reports  of  conditions  as  they  exist.  On  the  basis  of  these 
reports,  improvement  in  conditions  may  be  expected  to  continue 
for  many  years. 

Brief  summaries  of  surveys  supported  by  the  Foundation  in 
twelve  states  and  communities  follow  in  the  order  in  which  the 
studies  were  made. 


SOUTH  CAEOLINA 

Surveys  made  January,  1915 

Cost :    Services  of  Dr.  Salmon  and  some  $900  advanced  by 
Governor  Manning,  later  repaid  by  State  grant. 

Invitation :    Governor  of  South  Carolina,  who  was  urging 
upon  the  Legislature  new  laws  and  a  liberal  appropriation. 

Survey  in  charge:    Dr.   Arthur   P.    Herring,    Secretary   of 
Maryland  Lunacy  Commission,  Dr.  Salmon  supervising. 

[15] 


Report :    Shockingly  low  standard  of  care. 

Results :  One  month  after  report  State  Legislature  appro- 
priated $500,000  for  complete  remodeling  of  the  only  State 
hospital  and  for  placing  its  management  on  a  scientific  and 
modern  basis,  and  enacted  new  and  modern  statutes  regarding 
the  insane. 

Hospital  standards  transformed  from  those  of  1850  to  those 
of  the  present  day. 

An  institution  that  was  a  continual  source  of  scandal  and 
disgrace  up  to  three  years  ago  has  now  become  a  cause  for 
pride  to  the  people  of  the  State. 

TEXAS 

Survey  made  November-December,  1915 

Cost :  Dr.  Salmon's  services,  and  his  traveling  expenses, 
amounting  to  about  $500,  paid  by  the  National  Committee. 

Invitation :  Individuals  connected  with  State  University 
and  with  State  Conference  of  Charities  and  Corrections. 

Survey  in  charge :   Dr.  Salmon. 

Report:  Published  in  Dr.  Salmon's  notable  monograph 
"  The  Care  of  the  Insane  in  a  County  Poor-Farm." 

Results :  Dr.  Salmon  recommended  to  local  agencies  that 
Texas  establish  a  new  State  hospital  for  white  patients  and 
remodel  for  the  colored  insane  an  abandoned  prison,  as  this 
would  remove  from  jails,  lock-ups  and  poor  farms  the  several 
hundred  there  confined  and  suffering  hardships. 

The  State  Legislature  in  1917  acted  upon  Dr.  Salmon's  plan, 
and  appropriated  $400,000  for  a  new  hospital  for  the  white 
insane  to  accommodate  1,000,  and  $200,000  to  remodel  the  aban- 
doned prison  and  to  erect  a  new  building  for  the  negro  insane. 

The  State  Architect  of  Texas  has  consulted  the  National 
Committee  regarding  plans  for  the  new  State  hosirital. 

TENNESSEE 
Survey  made  October-December,  1915 

Cost:    $3,071.87. 

Invitation :   Tennessee  State  Board  of  Control. 

Survey  in  charge :  Dr.  Sidney  D.  Wilgus,  who  had  been 
superintendent  of  several  large  state  hospitals,  former  Chair- 

[16] 


man  of  New  York  State  Board  of  Alienists.  Dr.  Salmon  super- 
vised the  survey.  Supplementary  study  of  almshouses  in  1916 
by  Dr.  H.  S.  Hurlburt. 

Report :  State  care  at  very  low  standard.  County  care  of 
even  lower  standard. 

Detailed  reports  of  conditions  given  to  public  by  Tennessee 
authorities. 

A  significant  suggestion  of  the  report  is  the  establishment 
of  a  psychopathic  hospital  in  connection  with  the  Medical  School 
of  Vanderbilt  University,  to  serve  as  a  model  not  only  for 
Tennessee  but  for  the  entire  South. 

Results :  Tennessee  Board  of  Control  has  adopted  sugges- 
tions for  improvement  in  state  institutions  which  are  to  be  put 
into  effect  as  rapidly  as  funds  permit. 

Agitation  to  have  legislature  change  laws  regulating  com- 
mitment. 

State  Society  for  Mental  Hygiene — Chancellor  Kirkland  of 
Vanderbilt,  President — established  as  direct  result  of  survey. 


PENNSYLVANIA 

Survey  made  in  1914-1915,  Supplementary  Survey 
in  Winter,  1916-1917 

Cost :  Original  survey,  Dr.  Salmon's  services  and  $5,000, 
paid  by  Pennsylvania  Public  Charities  Association;  supple- 
mentary survey,  $1,421.51,  paid  by  Foundation. 

Invitation  :  Committee  on  Mental  Hygiene  of  Pennsylvania 
Public  Charities  Association,  sanctioned  by  Committee  on 
Lunacy  of  State  Board  of  Charities. 

Original  Survey  in  charge  :  Dr.  C.  Floyd  Haviland,  Dr.  Sal- 
mon supervising ;  supplementary  survey  in  charge  Dr.  William 
Sandy,  an  experienced  psychiatrist. 

Report :  Deficiencies  of  the  mixed  system  of  county  and 
state  care. 

Results :  Public  Charities  Association  provided  with  facts 
for  use  in  its  campaign  for  legislation  looking  toward  complete 
state  care  for  insane  and  correction  of  existing  defects. 

A  not  insignificant  result  of  the  survey  is  training  and  vision 
given  Dr.  Haviland,  who  was  in  charge  with  Dr.  Salmon  of 
original  survey  and  who  now,  as  Superintendent  of  the  Con- 
necticut State  Hospital  in  Connecticut,  is  developing  that 
institution  and  rendering  most  sympathetic  help  in  obtaining 
results  from  Connecticut  survey. 

[17] 


CALIFOBNIA 
Survey  made  February-May,  1916 

Cost:    About  $2,800. 

Invitation :  State  Board  of  Charities  and  State  Lunacy 
Commission. 

Survey  in  charge :  Dr.  George  H.  Kirby,  then  Clinical 
Director,  Manhattan  State  Hospital,  now  Director  of  New  York 
State  Psychiatric  Institute.     Dr.  Salmon  supervised  the  survey. 

Report :  Standards  of  custodial  care  good  with  some  excep- 
tions. Hospitals  badly  overcrowded.  Small  number  of  physi- 
cians, psychiatric  work  backward.  Poor  system  of  temporary 
care  in  jails  and  other  places  in  charge  of  sheriffs. 

Results  :  Introduction  of  bill  into  Legislature  providing  for 
establishment  of  psychopathic  hospital  in  San  Francisco  (not 
passed  but  to  be  fought  for  again.) 

Steps  for  reduction  of  overcrowding  in  State  institutions, 
providing  additional  accommodations  at  five  of  the  six  State 
institutions,  liberal  allowance  for  building  at  new  State  hospital. 

Appointment  of  well-trained  psychiatrists  as  Clinical  Direct- 
ors in  two  State  hospitals,  reorganization  of  medical  work, 
larger  number  of  physicians  provided. 

Adoption  of  modern  classification  of  metal  diseases. 


CONNECTICUT 
Survey  made  July-August,  1916 

Cost:   $1,449.12. 

Invitation  :   Connecticut  State  Board  of  Charities. 

Survey  in  charge :  Dr.  Sidney  D.  Wilgus,  Dr.  Salmon 
supervising. 

Report :  Conditions  which  have  been  remedied  in  part  as 
outlined  below. 

Results  :  Help  to  State  officials  and  Connecticut  Society  for 
Mental  Hygiene,  in  formulating  amendments  to  existing  statutes 
governing  commitment  and  care  of  insane  which  were  passed 
by  General  Assembly  of  1917. 

Further  results,  including  complete  state  care,  likely  to 
follow  use  of  report. 

[18] 


LOUISIANA 
Survey  made  in  1916 

Cost:   $1,534.72. 

Invitation  :  Louisiana  Society  for  Mental  Hygiene  and  State 
Board  of  Prisons  and  Asylums. 

Survey  in  charge  :  Dr.  Arthur  P.  Herring,  Secretary  of  the 
Maryland  State  Lunacy  Commission,  Dr.  Salmon  supervising. 

Report:  As  general  throughout  South,  standards  of  care 
for  insane  very  low. 

Chief  defects  lack  of  facilities  for  study  and  treatment  of 
early  and  acute  cases  of  mental  disorder,  lack  of  institution  for 
feebleminded  and  epileptic,  absence  of  central  supervision  of 
institutions,  and  existence  of  commitment  law  tending  to  ex- 
clude patients  from  hospitals  rather  than  to  facilitate  their 
admission. 

Eecommendations  include  establishment  of  state  psycho- 
pathic hospital  in  connection  with  the  Medical  Department  of 
Tulane  University. 

Results  :  It  is  believed  that  data  secured  will  lead  to  correc- 
tive legislation. 


GEOBGIA 

Survey  made  in  1916 

Cost:   $1,523.92. 

Invitation:  Governor  of  State  and  Board  of  Managers  of 
State  hospital. 

Survey  in  charge :  Dr.  Eichard  H.  Hutchings,  a  native  of 
Georgia,  for  several  years  Superintendent  of  St.  Lawrence  State 
Hospital,  Ogdensburg,  N.  Y.    Dr.  Salmon  supervised  the  survey. 

Report:  One  only  State  hospital,  sheltering  more  than 
4,200  patients,  including  insane,  inebriate,  feeble-minded,  of 
both  sexes  and  races.  This  had  grown  up  without  plans  except 
to  add  buildings  of  cheapest  construction  with  funds  saved 
from  allowance  for  support. 

Becommendation  for  provision  for  another  institution  for 
insane  near  Atlanta  and  an  institution  for  feeble-minded. 

Results:  Written  report,  submitting  plans  for  reorganiza- 
tion requested  by  Trustees  of  State  hospital,  was  approved  and 
will  serve  as  basis  for  future  improvements. 

Movement  is  under  way  to  organize  State  Society  for  Mental 
Hygiene. 

[19] 


NEW  YOEK  CITY 
Survey  made  September-  October,  1916 

Cost:    $1,689.00. 

Invitation :  Committee  on  Mental  Defectives  appointed  by 
Mayor  Mitchel  to  suggest  changes  in  New  York  City  practice. 

Survey  in  charge :  Dr.  George  H.  Kirby,  Dr.  Salmon  super- 
vising. 

Report :  Conditions  which  have  been  for  the  most  part 
remedied  as  noted  below. 

Results :  The  changes,  noted  below,  made  by  the  Mitchel 
city  administration,  were  based  on  facts,  conditions  and  recom- 
mendations brought  out  in  the  report : 

(a)  Psychopathic  clinic  established  in  the  Depart- 
ment of  Correction  for  the  mental  examination  of  all  new 
prisoners  with  funds  provided  by  the  city ;  a  visiting 
board  of  specialists  in  nervous  and  mental  diseases  and 
drug  addiction  appointed. 

(b)  Funds  allowed  for  the  reconstruction  of  a  build- 
ing to  be  used  as  a  clearing  house  which  will  provide 
permanently  for  a  psychiatric  clinic  in  the  Department 
of  Correction. 

(c)  Clinic  for  atypical  children  removed  to  Randall's 
Island,  providing  much  better  facilities  for  the  examina- 
tion of  patients,  additional  examining  clinics  in  Bronx 
and  Queens  Counties. 

(d)  Psychopathic  ward  at  Staten  Island  farm  colony 
reorganized  and  put  under  medical  supervision. 

(e)  Bellevue  Psychopathic  Ward  enlarged  and  moved 
into  new  quarters.  The  old  alcoholic  and  prison  wards 
abandoned  and  new  accommodation  provided  in  other 
hospital  buildings.  As  a  result  of  these  changes,  the 
number  of  beds  in  the  Psychopathic  Department  nearly 
doubled. 

(/)  Psychopathic  hospital,  which  seemed  likely  to  be 
recommended  by  the  last  city  administration,  has  been 
taken  up  by  the  State  Hospital  Development  Commission, 
who  recommend  the  establishment  of  a  hospital  for  200 
beds  in  New  York  City.  Dr.  Salmon  and  Dr.  Kirby 
appointed  on  the  Medical  Advisory  Board  of  the  State 

[20] 


Hospital  Development  Commission.  Governor  Whitman 
has  recommended  appropriation  of  $10,000.00  for  plans 
and  studies  for  a  Psychopathic  Hospital. 

(g)  Eeorganization  and  direction  of  the  work  of  the 
Psychopathic  Laboratory  of  the  Police  Department  under 
the  direction  of  Dr.  Salmon,  Dr.  Kirby  and  Dr.  Gregory. 


COLOEADO 

Survey  made  December,  1916-January,  1917 

Cost:   $1,497.80. 

Invitation :    Survey  Committee  of  State  Affairs. 

Survey  in  charge :  Dr.  Samuel  W.  Hamilton,  formerly  in 
New  York  State  Hospital  service,  Dr.  Salmon  supervising. 

Report :  Good  general  conditions.  No  almshouse  care.  De- 
fects in  the  single  State  institution  easily  dealt  with. 

A  State  care  act  had  just  been  passed  upon  popular 
initiative. 

Eecommendations  include  establishment  of  psychopathic 
hospital  in  Denver  in  connection  with  the  Medical  Department 
of  the  University  of  Colorado. 

Results :  Crystallization  of  feeling  already  alive  for  proper 
care  of  insane. 

Correction  of  minor  defects  in  the  State  institution  basis  for 
continued  advance. 


COOK  COUNTY,  ILLINOIS 
Survey  made  in  1917 
Cost:    $6,336.20. 

Invitation :  City  Club  of  Chicago  and  Illinois  Society  for 
Mental  Hygiene. 

Survey  in  charge :  Dr.  Herman  Adler,  then  of  the  staff  of 
the  Boston  Psychopathic  Hospital,  now  Director  of  Juvenile 
Psychopathic  Institute,  Chicago. 

Report :   Now  being  prepared,  includes  statement  of  condi- 
tions already  largely  remedied  as  noted  below. 

[21] 


Results :  The  following  improvements  in  Chicago  and  Cook 
County  were  made  on  basis  of  facts,  conditions  and  recom- 
mendations brought  out  by  this  report : 

(a)  Eeorganization  of  Cook  County  Psychopathic 
Hospital,  putting  it  on  a  modern  basis ; 

(b)  Kaising  standards  of  care  and  treatment  in  hos- 
pital and  systematizing  work  in  general ; 

(c)  Establishment  of  special  mental  clinic  for  chil- 
dren; 

(d)  Stimulation  of  local  interest  in  mental  defect 
and  psychopathic  conditions  in  relation  to  social 
problems;  and  coordination  of  agencies  working  in  this 
field. 

(e)  An  important,  indirect  influence  has  been  the 
reorganization  of  the  administration  of  the  State  hospitals 
and  the  criminological  service,  so  that  the  penal  institu- 
tions and  State  hospitals  are  now  under  direct  scientifical 
supervision. 

INDIANA 
Survey  made  October-December,  1917 
Cost :    About  $2,500. 

Invitation:  State  Board  of  Charities  and  Governor  of 
Indiana. 

Survey  in  charge :  Dr.  Sidney  D.  Wilgus,  Dr.  Salmon  super- 
vising. 

Report :   Now  being  prepared. 

Results :  Data  is  desired  by  State  Board  of  Charities  and 
the  Indiana  Society  for  Mental  Hygiene  to  secure  needed  legis- 
lation and  increased  institutional  facilities. 


[22  1 


IV.   STUDY  OE  CONDITIONS  IN  A 
COMMUNITY 

Problem  : 

The  prevalence  and  significance  of  mental  diseases  and 
deficiencies  in  given  communities  must  be  determined  before 
adequate  provision  to  meet  conditions  can  be  made. 

States  or  counties  attempting  to  make  adequate  provisions 
often  do  so  either  with  no  survey  of  conditions  or  with  one 
made  without  completeness  or  by  faulty  methods. 

Method  op  Attacking  the  Problem: 

One  method  of  assistance  is  to  make  a  scientific,  intensive 
study  of  a  given  community. 

Such  a  study — in  Nassau  County,  New  York — was  made  by 
the  National  Committee  with  Foundation  support. 


NASSAU  COUNTY,  N.  Y. 
DEMONSTRATION  INTENSIVE  SUEVEY 

Survey  made  during  four  months  in  1916 

Cost:  $10,000. 

Survey  carried  out  by  staff  of  six  physicians  and  seven  social 
workers,  under  supervision  of  advisory  board  of  National  Com- 
mittee for  Mental  Hygiene  and  Dr.  Salmon. 

Report:  Information  obtained  regarding  4,368  persons  in 
certain  areas  selected  for  intensive  study;  625  found  to  be 
feeble-minded,  retarded,  or  epileptic,  356  insane. 

Results :  Facts  and  conditions  accurately  reported  which 
are  of  value  in  considering  problems  of  other  communities. 

Standards  fixed  for  similar  surveys  elsewhere.  Most 
thorough  study  ever  made. 


[28] 


Y.    DEMONSTRATION   STUDIES   IN   THE 
PSYCHO-PATHOLOGY  OE  CRIME 

Problem  : 

Approximately  500,000  persons,  according  to  the  latest 
United  States  Census  Eeport,  annually  pass  through  the  cor- 
rectional and  penal  institutions  of  this  country  to  resume  their 
lives,  for  better  or  worse,  in  the  community.  Of  600  admissions 
to  Sing  Sing  Prison  during  a  recent  period  of  nine  months 
more  than  two-thirds  had  already  served  one  or  more  terms  in 
prisons  and  reformatories. 

Institutional  restraint  has  proved  its  failure  to  prevent 
relapse  into  criminal  courses. 

Method  of  Attacking  the  Problem: 

It  is  becoming  evident  that  before  correction  can  be  at  all 
efficacious  there  must  be  dependable  knowledge  of  the  individual 
weakness  and  needs  of  the  offender.  Without  such  knowledge 
correction  and  reform,  blindly  applied  to  assorted  masses  of 
prisoners,  serve  only  too  frequently  to  give  permanence  to 
criminal  tendencies  rather  than  to  develop  good  citizens  by 
correcting  causes  of  misconduct  and  tendencies  to  offend. 

The  Foundation  is  supporting  demonstration  studies  of  the 
underlying  causes  which  lead  to  crime  by  psychiatric  clinics  at 
Sing  Sing  Prison  and  at  the  Children's  Court  in  New  York  City. 

PSYCHIATRIC  CLINIC  AT  SING  SING  PRISON 
Conducted  1916  to  1918 

Cost:  From  July  1,  1916,  through  1918,  $25,000.  (It  is 
expected  that  the  State  of  New  York  will  soon  assume  support 
of  the  Clinic). 

Invitation :    Superintendent  of  Prisons. 

WorTc  in  charge :  Dr.  Bernard  Glueck,  supervised  by  an 
Advisory  Board  appointed  by  the  National  Committee. 

[24] 


Report :  Intensive  study  to  date  of  over  600  admissions  to 
Sing  Sing. 

Results :  Additional  light  on  psycho-pathology  of  crime ; 
importance  of  study  of  individual  rather  than  the  crime — data 
shows  that  a  very  high  percentage  of  prisoners  are  defective  or 
disordered  mentally. 

Direct  stimulus  to  establishment  of  a  reception  prison  for 
New  York  State,  which  has  been  approved  and  is  under  con- 
struction, in  which  criminals  may  be  sorted,  classified  and  sent 
to  prisons  or  hospitals  where  they  will  receive  best  curative 
treatment  or  permanent  detention  from  further  evil  to  society. 

Plan  furthered  for  providing  institution  for  mentally  defec- 
tive (feeble-minded). 

Other  states  already  influenced  in  prison  policy  by  results 
of  Sing  Sing  clinic. 


PSYCHIATEIC  CLINIC  IN  CHILDREN'S  COURT 
IN  NEW  YOEK  CITY 

Conducted  1917-1918 

Cost:  $8,920  from  July  1,  19 L7.  to  end  1918,  to  provide 
psychiatric  service  in  addition  to  that  furnished  by  city  for 
Children's  Court  in  New  York  City  and  branch  in  Brooklyn. 

Invitation  :   Judge  Hoyt  of  Children's  Court. 

Staff :  Consists  of  medical  director,  two  assistant  psychiat- 
ists,  one  psychologist,  one  social  worker  on  full  time,  two  social 
workers  on  half  time  and  two  stenographers. 

Work  of  the  Clinic  :  Psychiatric  examination  of  children  at 
designation  of  the  Judge,  study  of  home  conditions,  family  and 
environment.  Work  done  in  close  co-operation  with  j)robation 
officer  of  court. 

Results :  Cases  are  treated  by  Judge  in  light  of  full  facts, 
with  a  view  to  protecting  community  and  to  curing  rather  than 
simply  punishing  the  young  offender. 

Data  collected  by  these  studies  may  well  serve  as  basis  for 
valuable  scientific  research. 


[35] 


VI.    UNIFOEM  STATISTICS 

Problem  : 

Necessity  for  uniform  statistical  information  concerning 
mental  diseases,  if  this  information  is  to  be  of  any  value.  At 
present  widest  variety  of  nomenclature  used  in  different  states 
and  different  institutions.  Work  of  United  States  Census 
Bureau  wholly  incomplete.  No  other  agency  has  attempted  to 
make  any  statistical  compilation  of  national  scope.  For 
adequate  progress  in  treatment  there  must  be  general 
knowledge  of 

1.  Forms  of  mental  disease  occurring  in  all  parts  of 
country. 

2.  Movement  of  patients  in  every  hospital  of  insane. 

3.  Cost  of  maintenance  of  patients. 

4.  Personal  and  family  history  of  patients. 

Method  of  Attacking  the  Problem: 

The  Committee  on  Statistics  of  the  American  Medico- 
Psychological  Association,  Dr.  Salmon,  Chairman,  has  made 
definite  recommendations  concerning  establishment  of  uniform 
statistics.  The  Rockefeller  Foundation  has  agreed  to  support 
for  1918  the  work  of  the  National  Committee  in  bringing  such 
uniform  statistics  into  existence  and  having  them  adopted 
throughout  the  country.  It  is  estimated  that  it  will  require  five 
years  to  make  this  work  effective,  and  it  is  tacitly  understood 
that  the  Foundation  will  finance  this  activity  for  the  period 
mentioned.  Several  states  and  the  Surgeon-General  of  the 
United  States  Army  have  already  agreed  to  adopt  the  proposed 
uniform  statistics. 


[26] 


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